How much rates vary
Facilitymedian $468 · 10th to 90th $145 to $3,236Professionalmedian $166 · 10th to 90th $126 to $275
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $158.49 Median $891.25 Typical High $6,165.95 | Facility | None | $158.49 | $891.25 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $125.89 Median $165.96 Typical High $234.42 | Professional | None | $125.89 | $165.96 | $234.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $87.10 Median $112.20 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $87.10 | $112.20 | $125.89 |
Ambetter Setting Professional Modifier None Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | None | $83.18 | $83.18 | $83.18 |
AmeriHealth Setting Facility Modifier None Typical Low $562.34 Median $707.95 Typical High $8,912.51 | Facility | None | $562.34 | $707.95 | $8,912.51 |
AmeriHealth Setting Professional Modifier None Typical Low $91.20 Median $91.20 Typical High $95.50 | Professional | None | $91.20 | $91.20 | $95.50 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,630.27 Median $3,019.95 Typical High $56,234.13 | Facility | None | $2,630.27 | $3,019.95 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | None | $389.05 | $389.05 | $389.05 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $147.91 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $144.54 | $147.91 | $354.81 |
Cigna Setting Facility Modifier None Typical Low $138.04 Median $323.59 Typical High $549.54 | Facility | None | $138.04 | $323.59 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $128.82 Median $165.96 Typical High $281.84 | Professional | None | $128.82 | $165.96 | $281.84 |
Emblem Health Setting Professional Modifier None Typical Low $331.13 Median $331.13 Typical High $331.13 | Professional | None | $331.13 | $331.13 | $331.13 |
Geisinger Setting Facility Modifier None Typical Low $125.89 Median $158.49 Typical High $275.42 | Facility | None | $125.89 | $158.49 | $275.42 |
Geisinger Setting Professional Modifier None Typical Low $158.49 Median $229.09 Typical High $331.13 | Professional | None | $158.49 | $229.09 | $331.13 |
Highmark BCBS Setting Facility Modifier None Typical Low $190.55 Median $1,548.82 Typical High $3,235.94 | Facility | None | $190.55 | $1,548.82 | $3,235.94 |
Highmark BCBS Setting Professional Modifier None Typical Low $162.18 Median $186.21 Typical High $288.40 | Professional | None | $162.18 | $186.21 | $288.40 |
Independence Blue Cross Setting Facility Modifier None Typical Low $524.81 Median $707.95 Typical High $10,964.78 | Facility | None | $524.81 | $707.95 | $10,964.78 |
Independence Blue Cross Setting Professional Modifier None Typical Low $91.20 Median $91.20 Typical High $95.50 | Professional | None | $91.20 | $91.20 | $95.50 |
Martin's Point Setting Facility Modifier None Typical Low $165.96 Median $1,071.52 Typical High $6,025.60 | Facility | None | $165.96 | $1,071.52 | $6,025.60 |
Martin's Point Setting Professional Modifier None Typical Low $125.89 Median $165.96 Typical High $234.42 | Professional | None | $125.89 | $165.96 | $234.42 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $87.10 Median $114.82 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $87.10 | $114.82 | $125.89 |
Oscar Health Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $354.81 | Professional | None | $194.98 | $194.98 | $354.81 |
UPMC Health Plan Setting Facility Modifier None Typical Low $128.82 Median $812.83 Typical High $1,862.09 | Facility | None | $128.82 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $128.82 Median $173.78 Typical High $186.21 | Professional | None | $128.82 | $173.78 | $186.21 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $2,089.30 | Facility | None | $199.53 | $436.52 | $2,089.30 |
United Setting Professional Modifier None Typical Low $128.82 Median $173.78 Typical High $302.00 | Professional | None | $128.82 | $173.78 | $302.00 |
10 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $63.10 Median $81.28 Typical High $89.13 | Professional | 52 · Reduced service | $63.10 | $81.28 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $32.36 Typical High $35.48 | Professional | 53 · Discontinued | $25.12 | $32.36 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $120.23 Typical High $134.90 | Professional | 54 · Surgery only | $93.33 | $120.23 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $23.99 Typical High $26.92 | Professional | 55 · Aftercare only | $19.05 | $23.99 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $16.22 Typical High $17.78 | Professional | 56 · Pre-op care only | $12.59 | $16.22 | $17.78 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $63.10 Median $81.28 Typical High $89.13 | Professional | 52 · Reduced service | $63.10 | $81.28 | $89.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $32.36 Typical High $35.48 | Professional | 53 · Discontinued | $25.12 | $32.36 | $35.48 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $123.03 Typical High $134.90 | Professional | 54 · Surgery only | $93.33 | $123.03 | $134.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $24.55 Typical High $26.92 | Professional | 55 · Aftercare only | $19.05 | $24.55 | $26.92 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $16.22 Typical High $17.78 | Professional | 56 · Pre-op care only | $12.59 | $16.22 | $17.78 |
Where Pennsylvania sits
The same service costs 3.9 times more in Alaska than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Pennsylvania· 46th of 51
$174
AK $603KY $155
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.